Handbook of Sepsis

Abstract

This practically oriented book provides an up-to-date overview of all significant aspects of the pathogenesis of sepsis and its management, including within the intensive care unit. Readers will find information on the involvement of the coagulation and endocrine systems during sepsis and on the use of biomarkers to diagnose sepsis and allow early intervention. International clinical practice guidelines for the management of sepsis are presented, and individual chapters focus on aspects such as fluid resuscitation, vasopressor therapy, response to multiorgan failure, antimicrobial therapy, and adjunctive immunotherapy. The closing section looks forward to the coming decade, discussing novel trial designs, sepsis in low- and middle-income countries, and emerging management approaches. The book is international in scope, with contributions from leading experts worldwide. It will be of value to residents and professionals/practitioners in the fields of infectious diseases and internal medicine, as well as to GPs and medical students. Intro; Preface; Contents; Part I: Sepsis: An Overview; 1: What Is Sepsis?; 1.1 Introduction; 1.2 The Origins of Sepsis; 1.3 Sepsis Was About Inflammation and Not the Pathogen; 1.4 Sepsis Is Now About Organ Dysfunction and Not Inflammation; 1.5 Multiple Organ Dysfunction; 1.6 Clinical Recognition of Sepsis; 1.7 Risk Factors and Disease Course; 1.8 Finding a Cure for Sepsis; 1.9 Clinical and Public Misunderstandings; 1.10 Challenges and the Way Forward; References; 2: The Epidemiology of Sepsis; 2.1 Introduction; 2.2 Incidence and Acute Mortality. 2.2.1 Sepsis Incidence and Outcomes by Age2.2.2 Changes in Incidence and Outcomes Over Time; 2.2.3 Sepsis Incidence by Chronic Medical Conditions; 2.2.4 Maternal Sepsis; 2.2.5 Sepsis Incidence by Demographics and Socioeconomic Status; 2.3 Etiology and Characteristics of Sepsis; 2.3.1 Context; 2.3.2 Site of Infection; 2.3.3 Pathogen; 2.3.4 Acute Organ Dysfunction and Failure; 2.4 Long-Term Outcomes; 2.4.1 Late Mortality; 2.4.2 Physical, Cognitive, and Mental Health Impairment; 2.4.3 Healthcare Utilization and Hospital Readmission; 2.4.4 Recurrent Sepsis. 2.4.5 Cardiovascular EventsReferences; Part II: The Pathogenesis of Sepsis; 3: Pathogenesis of Sepsis; 3.1 Introduction; 3.2 Pathogens and Infection Sites; 3.3 Host Recognition of Pathogens; 3.4 Hyperinflammation; 3.4.1 Complement System; 3.4.2 Coagulation System and Vascular Endothelium; 3.4.3 Neutrophil Extracellular Traps; 3.5 Immune Suppression; 3.5.1 Apoptosis of Immune Cells; 3.5.2 Reprogramming of Monocytes and Macrophages; 3.5.3 Cellular Metabolism; 3.6 Microbiome; References; 4: The Coagulation System in Sepsis; 4.1 Sepsis and Coagulation. 4.2 Frequency of Clinically Relevant Coagulopathy in Sepsis4.3 Pathways Leading to Coagulation Abnormalities in Sepsis; 4.4 Inflammation and the Coagulopathy of Sepsis; 4.5 Diagnosis of the Coagulopathy in Sepsis; 4.6 Supportive Treatment of Coagulation Abnormalities in Sepsis; 4.7 New Pathways and Targets in the Management of DIC; References; 5: The Endocrine System in Sepsis; 5.1 The Endocrine System; 5.1.1 Introduction; 5.1.2 Hormone Secretion Control Mechanisms; 5.1.3 Organization of the Endocrine System; 5.1.3.1 The Adrenergic System; 5.1.3.2 The Pituitary Hypothalamic Axis. 5.1.3.3 The Adrenal Glands5.1.3.4 Vasopressin; 5.1.3.5 Insulin; 5.1.3.6 The Thyroid Gland; 5.1.3.7 The Somatotropic Axis; 5.1.3.8 Sex Hormones; 5.2 The Endocrine Response to Stress; 5.3 Endocrine Alterations During Sepsis; 5.3.1 The Adrenergic System; 5.3.2 The Hypothalamic-Pituitary-Adrenal Axis; 5.3.2.1 Corticosteroids in Septic Shock; 5.3.3 Vasopressin; 5.3.4 Insulin; 5.3.5 Thyroid Hormones; 5.3.6 Growth Hormone; 5.3.7 Androgens; References; 6: Sepsis Biomarkers; 6.1 Introduction; 6.2 Biomarkers; 6.2.1 C-Reactive Protein; 6.2.2 Procalcitonin; 6.2.3 CD64.